Briana Contreras

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Healthcare workers, residents of long-term care facilities, and many public leaders have been the first to receive a Covid-19 vaccine in the U.S., but it’s essential to consider disadvantaged communities for phase 2 of vaccine deployment.

Manik Bhat, founder and CEO of Healthify, who is working to address social determinants of health, shares the importance of prioritizing minority groups and communities of color to receive the vaccine in its next deployment – which varies from state to state based on local implementation guidelines, epidemiology and demand.

These groups should be a priority because of their increased risk for infection and complications from COVID-19.

For example, studies have shown African-Americans already have higher rates and earlier onset of chronic conditions and disability than white Americans. In addition, they face a number of socioeconomic challenges that can impact overall health and wellbeing. Lastly, they have less access to COVID-19 testing, as living in less affluent areas there are fewer tests and testing sites available. This confluence of challenges in accessing care, lower rates of health insurance, and a reluctance to seek testing and care is a potentially devastating concoction, Bhat says.

Other social determinants of health that contribute to the spread of viral diseases and worsen the issues for individuals already struggling are factors such as housing, education and occupation.



growing and disproportionate unemployment rates during the COVID-19 pandemic lead to risk of eviction and homelessness or sharing of housing. Housing insecure families that live in crowded conditions makes it more challenging to follow prevention strategies, Bhat shares. Another example is people with limited job options have less flexibility to leave jobs that may put them at a higher risk of exposure to the virus that causes COVID-19.

Those in these situations often cannot afford to miss work as they are financially insecure as well so even if they’re sick it is difficult to leave and there isn't enough money saved up for essential items like food and other important living needs.

Lastly, individuals from racial and ethnic minority groups are 

 represented in essential work settings such as healthcare facilities, farms, factories, grocery stores and public transportation. Those who work in these settings have a higher risk of exposure to COVID-19 because of factors including close contact with the public, not being able to work from home and not having paid sick days.

the COVID-19 pandemic is shining a light on the link between social disparities, health outcomes, and issues for vulnerable populations that are already struggling. As the number of COVID-19 infections rise and economic hardships surge, Bhat says now is the time to invest in community-based services that right the wrongs of social disparities among minorities.

“The spread of COVID-19 in the U.S. has made stark how our fragmented care systems leaves our most vulnerable community members at heightened risk,” he says. “Unfortunately, the pandemic has disproportionately affected certain minority populations who contribute to a majority of service industry jobs which have been heavily affected by unemployment or are at an increased risk of contracting the virus. There is a clear need to invest in social service organizations and ensure treatment of these communities as a step to address social and economic issues to improve the health and wellbeing of vulnerable populations and enable them to recover.”

Investing in these organizations first starts with robust data-sharing and community networks that allow people to better understand social needs at the community and individual levels. Starting with an infrastructure that enables healthcare and social services organizationsto coordinate medical and social care, and increase access to the vaccine, also helps bring the vaccine closer to these communities.

Bridging this gap will require input, resources, commitment ,and collaboration from multiple stakeholders: payers, providers, government entities, and community service organizations, according to Bhat.

“Collaboration with community-based organizations is critical if we really want to address the indirect conditions — the social determinants of health — that affect health equity and ensure that vulnerable communities are a priority group to receive the vaccine,” he says. “Food banks, job placement services, childcare providers and other local community organizations are best poised to understand the needs of their community members and to help reach people where they live.”

Bhat adds that radically improving health outcomes for vulnerable populations requires a multifaceted, proactive, community-wide approach focused on better understanding social determinants of health and simultaneously addressing social and health inequalities. Equally important is the need to increase capacity for social services and funding for community-level support systems to ensure we can address gaps in both social needs and healthcare.

“Action needs to happen now to invest in community services to make racial health equity achievable and sustainable,” he says.

Articles

Healthcare workers, residents of long-term care facilities, and many public leaders have been the first to receive a Covid-19 vaccine in the U.S., but it’s essential to consider disadvantaged communities for phase 2 of vaccine deployment.


Those Facing SDoH Should be a Priority in Receiving COVID Vaccine

Podcasts

In this week’s episode of Tuning In to the C-Suite podcast, MHE's Senior Editor Peter Wehrwein and Associate Editor Briana Contreras spoke with CEO of Syntellis Performance Solutions, Kermit Randa. In the discussion they talked about a recently released survey by Syntellis called the 2021 Healthcare Financial Trends Survey report, which highlights how finance leaders pivoted in 2020 and the way they will continue to evolve in 2021.


2021 Healthcare Financial Trends per Kermit Randa of Syntellis Performance Solutions

MHE's Peter Wehrwein talks with Lloyd Dean, CEO of Dignity Health and CommonSpirit, and Valerie Montgomery Rice, M.D., FACOG, president of Morehouse School of Medicine, in this new episode of MHE Talks: Improving Patient Access podcast series. The three discuss the lack of Black physicians in the United States. Of the 22,000 medical school applicants in the U.S. every year, only 1,600 are Black. Dean and Rice created a program that seeks to cross barriers of healthcare and racial disparities by offering more opportunities for students of color in medical school programs.

Morehouse School of Medicine, CommonSpirit Tackle Healthcare Disparities in new Scholar Program 

The post office has been a source of instability in a rather unstable time in general. So did you change how you got that medication delivered to people's homes as a result of concerns about the capacity of the post office?

 So we certainly discussed it in the early days. And we discussed it really in two ways: one is relative to mail and postal service and delivery and logistically the options around that, and geographic differences, because one might like to think that it's a national problem. But really, it might be limited to one community versus another. So a very operational and granular approach is taken to make sure that's managed from a logistics point of view. 

But I think, in addition to that, we thought about retail and mail in the same setting, and because if you were, let's say in a stay-at-home order, you couldn't go to your retail pharmacy. And at the beginning, if we again reflect back to the beginning of this, many of them were closed, whether it be the social unrest that happened or the early days of stay-at-home order, you couldn't even go to the retail pharmacy to get it. 

So what we did there in terms of change, we moved very quickly. Another area that I'm quite proud of, is we removed any refill too soon - requirements that may have prevented someone from getting an extra script. And we did it through a system change. So you didn't have to call in the early days. The call volumes were really high. We wanted to avoid that disruption for the members so they could get an extra prescription and have it on hand. And so we changed the policy, we informed our members and a number of members were able to then have extra supply, which then mitigated some of the issues that you raised around how long it would take for a medicine to come in terms of home infusion and the increased use of home infusion. 

 Have you seen any sort of increase in the number of prescriptions for antidepressants or anti anxiety drugs that would reflect be a data point that would verify this concern that people have about the effects of the pandemic?

 What we've seen is anti-depressants are up over 10%. So to your point, people are feeling the effects of this pandemic, the stress of the pandemic, the economic toll that many of our fellow Americans are experiencing. And being empathic, cognizant, and then having resources to help, again is, it's a privilege to be in a position to be able to do that.

 What two or three things you see as having sort of staying power, where you discovered something about the way your business works that is going to continue, even as life returns to a new normal?

Well, I think we should start by this, we're having this conversation in a way that most likely would have been in person before. And I can tell you as we end 2020, versus when we began, that the connection that I can develop with you, in this way, is much better and deeper than than I thought it could ever be. And that's directly applicable to how we serve our patients. 

As organizations increasingly have taken to resources that do not require face-to-face, interaction that's aligned with how we've invested in the business, and the capabilities we've developed, specifically digital capabilities, around getting information around price of drugs, being able to order drugs, and also offering services that are not necessarily just prescription drugs, but adjacent needs to our optimum store, those are all capabilities that are important.

Videos

Sumit Dutta, MD, MBA, of OptumRx, talks to MHE about drug use among Americans during the COVID-19 pandemic and about vaccine distribution to its members in this part two of a two-part video interview series.

Briana Contreras

Articles

Those Facing SDoH Should be a Priority in Receiving COVID Vaccine

2021 Healthcare Financial Trends per Kermit Randa of Syntellis Performance Solutions

Morehouse School of Medicine, CommonSpirit Tackle Healthcare Disparities in new Scholar Program

Drug use, Distribution Among Members of OptumRx